EGFR tyrosine-kinase-activating mutations are present in 10-26% of NSCLCtumors and are a/wincreased response to Gefitinib and Erlotinib. NSCLC typically affecting people over 70 years of age are not in a good general condition to receive systemic therapy. Recommended therapy is 3rd generation single agent chemotherapy in elderly patients. Erlotinib, an oral EGFR TKI, has been found to be an effective 2nd line and maintenance therapy in advanced NSCLC, besides being a safe drug. In this study we evaluated the efficacy and safety of erlotinib after radiotherapy in the treatment of advanced NSCLC and non squamous histology in the elderly patients.
In this retrospective study a total of 40 elderly patients of biopsy proven NSCLC and non squamous histology, with stage IIIB/IV were analyzed from Jan 2013 to Dec 2014. All patients were planned with external beam radiotherapy with IMRT technique for dose of 45-60 Gy followed by oral Erlotinib @ 150 mg daily. All the patients were analyzed for progression free survival and overall survival.
All the patients completed the scheduled radiation. Partial response in 12, stable disease in 18 for a response rate of 25% and a disease control rate of 55% were found. Out of 10 patients 6 died of progressive disease between 3 and 10 months and 4 patients were lost to follow up. Common adverse events were skin rash 40%, (gr II-III-15%), diarrhoea 25%. Only 4 patients needed dose reduction of Erlotinib to 100 mg due to grade III rashes in 3rd cycle. EGFR mutational analysis available for 10 patients, 4 were found positive for the mutation. The patients who improved after local RT have shown to tolerate the further oral chemotherapy better.
Erlotinib monotherapy with local RT is an effective and a well tolerated promising treatment option for the treatment of advanced NSCLC and non squamous histology in the elderly patients in terms of tolerability and efficacy.
Clinical trial identification
All authors have declared no conflicts of interest.